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Knee osteoarthritis is a degenerative disorder of the knee, which leads to joint pain, stiffness, and inactivity and significantly affects the quality of life. With an increased prevalence of obesity and greater life expectancies, total knee arthroplasty (TKA) is now one of the major arthroplasty surgeries performed for knee osteoarthritis. When enhanced recovery after surgery (ERAS) was introduced in TKA, clinical outcomes were enhanced and the economic burden on the healthcare system was reduced. ERAS is an evidence-based scientific protocol aimed at ameliorating the surgical stress response. ERAS aims to enhance the recovery phase, which encompasses multidisciplinary strategies at every step of perioperative care, including the rehabilitation phase. Implementation of ERAS in TKA aids in reducing the length of hospital stay, improving pain management, reducing perioperative complications, and enhancing patient satisfaction. Multidisciplinary collaboration, integrating the expertise of anesthesiologists, orthopedic surgeons, nursing personnel, and other healthcare professionals, is the cornerstone of ERAS in patients undergoing TKA.
RESUMO
Obstructive sleep apnea (OSA) is now increasingly recognized as a disease entity that can play a major role in affecting multiple organ systems. Even though the symptoms of OSA were first described in the 19th century as Pickwickian syndrome, there are a lot of things that came to be known only recently including its pathophysiology and diagnosis. In this case report, we present some findings that mostly have not been reported in OSA patients before. It has been reported that OSA patients have a typical arterial blood gas (ABG) picture of raised bicarbonate (HCO3-) levels, which also aid in adding to the diagnosis, but we found some more findings that are only specific to the apneic phase of the disease. A 65-year-old female patient was put on a ventilator due to dengue-associated acute respiratory distress syndrome (ARDS). She was also diagnosed with obstructive sleep apnea after facing difficulty in weaning from a ventilator. Post extubation, she was put on noninvasive ventilation (NIV), but the patient's arterial blood gas (ABG) drawn during the apneic phase was showing signs of severe metabolic acidosis even on NIV. This was reversible and gets corrected once the patient is awakened or put on NIV. Clinical decisions from ABG in a patient with OSA may result in errors especially when the ABG is drawn during the apneic phase of the disease. Clinicians have to be careful of this phenomenon, and more research needs to be undertaken to fully understand the pathophysiology of this phenomenon.
RESUMO
INTRODUCTION: Body mass index (BMI) has been used for a long period as a surrogative measure for obesity. But BMI does not differentiate between fat and nonfat tissue (blood, bone, and muscle) due to which it is not considered accurate anymore. But since BMI is easier to estimate and used widely for assessment of obesity, it is better if it is re-standardized according to the body fat percentage (BFP) of a specific population, community, and their ethnicity. OBJECTIVE: To estimate and propose the BMI cut-off values in young Indian population especially MBBS students taking BFP as a standard. DESIGN: This is a cross-sectional study. Anthropometric data (age, gender, height, weight, waist circumference, and hip circumference) were collected from the participants after taking consent. BMI was calculated using Quetelet's Rule. BFP was estimated using Omron Body fat Monitor (HBF 385). It measures the BFP by the bioelectrical impedance (BI) method. Data were analyzed with appropriate statistical tests and receiver operating curve (ROC) curves were drawn to find the cut-off values of BMI to determine obesity. SETTING: The present study is a multi-centric study conducted in four medical colleges (two in each state; Odisha and Andhra Pradesh, India). PARTICIPANTS: Apparently healthy MBBS students aged 18-24 years were included in this study. Students having any chronic or acute illnesses were excluded from the study. Out of 904 students contacted from four medical colleges, 863 (430 males and 433 females) consented and participated. RESULTS: Some 863 MBBS students have participated in this study. After adjusting for age, BMI was found to be higher in males. BMI was found to be 29.33 for males and in females it was 29.06. BFP was higher in females (34.23) as compared to males (20.77). Waist hip ratio was found to be higher in females (0.92) than in males (0.84). Whereas, fat free mass (FFM) and fat free mass index (FFMI) are higher in males, i.e., 56.24 and 18.48 respectively. Most appropriate cut-off value for obesity on ROC curve was found to be 22.09 (sensitivity 84.5%, specificity 83.46%) in males and that of females was 23.73 (sensitivity 85.26, specificity 81.23). Whereas, the conventional cut-off of 25 for males had sensitivity of only 46% and that of females was 70.5%. For total population BMI cut-off value was found to be 22.2 with 81% sensitivity and 74% specificity. Conclusion: We propose the cut-off value for overweight/obesity in males to be 22.09 kg/m2 and for females to be 23.73 kg/m2 in young adult Indian population. These values were found to have more sensitivity and specificity than current BMI cut-off value.
